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J Pediatr. 2012 Oct;161(4):716-722.e1. doi: 10.1016/j.jpeds.2012.03.046. Epub 2012 May 11.

Risk factors for mortality in children with abusive head trauma.

Author information

1
Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15260, USA. drstevenshein@gmail.com

Abstract

OBJECTIVE:

We sought to identify risk factors for mortality in a large clinical cohort of children with abusive head trauma.

STUDY DESIGN:

Bivariate analysis and multivariable logistic regression models identified demographic, physical examination, and radiologic findings associated with in-hospital mortality of children with abusive head trauma at 4 pediatric centers. An initial Glasgow Coma Scale (GCS) ≤ 8 defined severe abusive head trauma. Data are shown as OR (95% CI).

RESULTS:

Analysis included 386 children with abusive head trauma. Multivariable analysis showed children with initial GCS either 3 or 4-5 had increased mortality vs children with GCS 12-15 (OR = 57.8; 95% CI, 12.1-277.6 and OR = 15.6; 95% CI, 2.6-95.1, respectively, P < .001). Additionally, retinal hemorrhage (RH), intraparenchymal hemorrhage, and cerebral edema were independently associated with mortality. In the subgroup with severe abusive head trauma and RH (n = 117), cerebral edema and initial GCS of 3 or 4-5 were independently associated with mortality. Chronic subdural hematoma was independently associated with survival.

CONCLUSIONS:

Low initial GCS score, RH, intraparenchymal hemorrhage, and cerebral edema are independently associated with mortality in abusive head trauma. Knowledge of these risk factors may enable researchers and clinicians to improve the care of these vulnerable children.

PMID:
22578583
PMCID:
PMC3437227
DOI:
10.1016/j.jpeds.2012.03.046
[Indexed for MEDLINE]
Free PMC Article

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